Pain Management Update

Do opioids work for back and neck pain?

A landmark study published June 2023 in The Lancet medical journal demonstrates that opioids are no better than placebo for back and neck pain.

Despite widespread prescription of opioid medication for acute back and neck pain, many people report little or no benefit. Senior author and researcher involved in the OPAL Trial, funded by the NHMRC at the University of Sydney, Professor Christine Lin, stated “before this trial, we did not have good evidence on whether opioids were effective for acute low back pain or neck pain yet opioids were one of the most commonly used medicines for these conditions”. This study showed: no difference in pain severity ratings between the placebo and the prescribed oxycodone at 6 weeks; better quality of life in the placebo group; and increased risk of opioid misuse at 12 months. Professor Lin went on to say that on the basis of these results, “opioids should not be recommended at all for acute low back pain and neck pain.”[1]

As physiotherapists and rehabilitation providers we are familiar with the situation faced by doctors when trying to help someone who presents with pain; All health care providers want to help. However, historical practices and patient expectations should not underpin treatment. While opioids still have a place in pain management, the evidence is growing that their risks outweigh their benefits in back and neck pain and that they may well be no more useful than a placebo.

The good news is that clinical guidelines for back pain are well established. Our article following the release of guidelines in 2018,  Back pain: What Really Works?,  highlighted the efficacy and importance of education, reassurance, tailored exercise and graduated return to work. 

As far as education goes, there are excellent free and low-cost resources available to complement treatments provided by GPs and physiotherapists:

Rehabilitation Consultants at Back on Track remain across new developments in the management of pain, injury and disability. We work with injured and ill people to provide support for recovery through safe, effective and evidence-based treatment.

[1] Caitlin J et al (2023) Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. Lancet 2023:S014067362300404X